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Asymmetric ARDS Following Pulmonary Resection: CT Findings—Initial Observations¹

¹ From the Departments of Radiology (S.P.G.P., D.M.H.), Surgery (P.G.), Critical Care Medicine (S.J.J.), and Respiratory Medicine (A.U.W.), Royal Brompton Hospital, Fulham Rd, London SW3 6NP, England. Received April 4, 2001; revision requested May 23; revision received August 13; accepted September 28. Address correspondence to S.P.G.P. (e-mail: s.padley@ic.ac.uk).

View larger version (142K): [in a new window]   Figure 1a. Transverse CT images obtained before and after surgery. (a) Two ROIs are shown in the posterior lung parenchyma. This patient subsequently underwent left upper lobectomy. The anterior pair of ROIs are not demonstrated. (b) Image shows postoperative development of ARDS, with two posterior ROIs positioned at an equivalent anatomic location. Again, the anterior pair of ROIs are not demonstrated, since the workstation is able to display only two ROIs at a time.

View larger version (151K): [in a new window]   Figure 1b. Transverse CT images obtained before and after surgery. (a) Two ROIs are shown in the posterior lung parenchyma. This patient subsequently underwent left upper lobectomy. The anterior pair of ROIs are not demonstrated. (b) Image shows postoperative development of ARDS, with two posterior ROIs positioned at an equivalent anatomic location. Again, the anterior pair of ROIs are not demonstrated, since the workstation is able to display only two ROIs at a time.

View larger version (141K): [in a new window]   Figure 2a. Transverse CT images displayed at lung window settings demonstrate postoperative CT changes in three representative patients. The side of resection was (a) right, (b) left, and (c) right. There is marked asymmetry of parenchymal opacity in each case. The changes—namely, ground glass parenchymal opacification, increased prominence of interlobular septa, and an anteroposterior opacity gradient—are consistent with PLE. The changes are more marked in the nonoperated lung in each case. The small pleural effusions were excluded from the volume measurements. Areas of intense parenchymal opacification (evident posteriorly in a and b) were avoided during ROI placement.

View larger version (144K): [in a new window]   Figure 2b. Transverse CT images displayed at lung window settings demonstrate postoperative CT changes in three representative patients. The side of resection was (a) right, (b) left, and (c) right. There is marked asymmetry of parenchymal opacity in each case. The changes—namely, ground glass parenchymal opacification, increased prominence of interlobular septa, and an anteroposterior opacity gradient—are consistent with PLE. The changes are more marked in the nonoperated lung in each case. The small pleural effusions were excluded from the volume measurements. Areas of intense parenchymal opacification (evident posteriorly in a and b) were avoided during ROI placement.

View larger version (155K): [in a new window]   Figure 2c. Transverse CT images displayed at lung window settings demonstrate postoperative CT changes in three representative patients. The side of resection was (a) right, (b) left, and (c) right. There is marked asymmetry of parenchymal opacity in each case. The changes—namely, ground glass parenchymal opacification, increased prominence of interlobular septa, and an anteroposterior opacity gradient—are consistent with PLE. The changes are more marked in the nonoperated lung in each case. The small pleural effusions were excluded from the volume measurements. Areas of intense parenchymal opacification (evident posteriorly in a and b) were avoided during ROI placement.

View larger version (22K): [in a new window]   Figure 3. Pulmonary CT density change following surgery and development of ARDS. The plot demonstrates the change relative to expected density for the operated and nonoperated lungs in each case. In all patients, there was an increase in density in the nonoperated lung, while in the operated lung, density increased, decreased, or stayed the same. Possible explanations are explored in the Discussion.